ch 32 diuretics

A patient with a longstanding diagnosis of chronic renal failure has experienced a significant decline in urine output in recent days, prompting him to seek care at a local clinic. A nurse at the clinic has suggested to a colleague that the administration of a diuretic such as hydrochlorothiazide may improve the patient's urine output. How should the colleague best respond to this suggestion?

"Actually, patients with renal failure usually can't take hydrochlorothiazide."

After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states:

"I need to make sure I don't eat too many high potassium foods."

The nurse is teaching a 62-year-old client about hydrochlorothiazide, which the health care provider has prescribed for treatment of hypertension. What statement, made by the client, suggests that the client understands the teaching?

"I will need to stand slowly."

Which instruction would be most appropriate for a client who is taking a diuretic?

"It's okay to take it with food."

A client asks, "Why is my prescription being switched from furosemide to spironolactone?" What is the nurse's best response?

"You will lose less potassium with spironolactone than with furosemide."

A client is receiving hydrochlorothiazide. The nurse would expect this drug to begin acting within which time frame?

2 hours

The nurse is administering furosemide IV to a client. How soon after administration does the nurse expect diuretic effects to peak?

30 minutes

client receives a dose of furosemide intravenously at 8:00 AM. The nurse would expect this drug to exert is peak effects at which time?

8:30 am

A patient receives furosemide intravenously at 9 AM. The nurse would expect to assess peak effects of the drug at which time?

9:30 am

A nurse is caring for a client with acute renal failure. The health care provider has prescribed a diuretic therapy for the client to promote dieresis. What intervention should the nurse perform to prevent the inconvenience caused by increased urination?

Administer the drug early in the day.

What would be a contraindication to the use of carbonic anhydrase inhibitors?

Allergy to sulfonamides

A 75-year-old client is diagnosed with atrial fibrillation and chronic congestive heart failure. The health care provider orders a combination of digoxin and diuretics to treat the client's diseases. Recent laboratory results indicate that the client's potassium level is 2 mEq/L. This client is at risk for which problem?

Digoxin toxicity

A client has been prescribed both digoxin and furosemide. The nurse should monitor the client for development of what adverse effect?

Digoxin toxicity

After teaching a group of nursing students about diuretics, the instructor determines that the teaching was successful when the group identifies which as a loop diuretic?

Furosemide

An elderly patient with a history of congestive heart failure has been admitted to hospital with failure to thrive and admission blood work reveals a hemoglobin level of 6.9 g/dL. The care team has consequently administered two units of packed red blood cells, but auscultation of the client's lungs now reveals diffuse crackles. Administration of what drug is likely to resolve the patient's pulmonary edema?

Furosemide

Which diuretic will most likely be the initial drug of choice when a client demonstrates dyspnea related to pulmonary edema?

Furosemide

A male client is critically ill with a diagnosis of congestive heart failure exacerbated by a myocardial infarction. The nurse understands that what fast-acting diuretics would be appropriate for the health care provider to order? (Select all that apply.)

Furosemide Bumetanide

Which is an example of a loop diuretic?

Furosemide (Lasix)

A client prescribed both an ACE inhibitor and a beta-blocker for the treatment of hypertension has been consistently obtaining blood pressure readings in the vicinity of 145/90 mm Hg. As a result, the client's primary health care provider has prescribed furosemide. What order would be most consistent with this client's health needs?

Furosemide 40 mg PO BID

A male client has cirrhosis of the liver that has caused ascites. The nurse knows that what condition may occur if diuretics are used to reduce the ascites?

Hepatic encephalopathy Diuretics are often used to manage edema and ascites in clients with hepatic impairment. These drugs must be used with caution, because diuretic-induced fluid and electrolyte imbalances may precipitate or worsen hepatic encephalopathy and coma.

A 91-year-old client, who is being prepared for discharge, has been prescribed the diuretic spironolactone. While teaching the client about the drug, what major adverse effect should the nurse be sure to mention?

Hyperkalemia The major adverse effect of potassium-sparing diuretics such as spironolactone is hyperkalemia. Clients receiving these drugs should not be given potassium supplements and should not be encouraged to eat foods high in potassium.

A client who has been taking hydrochlorothiazide arrives at the clinic for his 1-month follow-up appointment. The client tells the nurse that he feels weaker since he began taking the drug. What should the nurse consider as a possible cause of these symptoms?

Hypokalemia Thiazides, such as hydrochlorothiazide, are potassium-losing diuretics, and their use can lead to hypokalemia. Symptoms of hypokalemia include muscle weakness, dysrhythmia, hypotension, anorexia, and and shallow respirations.

A health care provider has prescribed triamterene to a male client with renal disease. The client informs the nurse that he is taking potassium supplements to address some heart problems. The nurse would be alert for:

Increased risk of hyperkalemia

When describing where bumetanide acts, what would the nurse include?

Loop of Henle Bumetanide is a loop diuretic that blocks the chloride pump in the ascending loop of Henle. It also has a similar effect in the descending loop and in the distal convoluted tubule.

A client is diagnosed with increased intracranial pressure. Which would the nurse expect to be ordered?

Mannitol

The nurse is caring for a client who is experiencing elevated intracranial pressure following neurosurgery. The health care provider orders an osmotic diuretic to reduce pressure. Which medication would the nurse expect to be ordered?

Mannitol

The pharmacology instructor is discussing the differences among the various diuretic agents. Which would the instructor cite as a difference between spironolactone and hydrochlorothiazide?

Potassium losses are greater with hydrochlorothiazide than with spironolactone.

What substance is reabsorbed in the ascending limb of the loop of Henle?

Sodium

A male client has cirrhosis and is receiving diuretic therapy. The nurse knows that what drug will help prevent metabolic alkalosis or hypokalemia in this client?

Spironolactone For clients with cirrhosis, diuretic therapy should be initiated in a hospital setting, with small doses and careful monitoring. To prevent hypokalemia and metabolic alkalosis, supplemental potassium or spironolactone may be needed.

The health care provider indicates that a client experiencing renal failure is not a candidate for therapy with potassium-sparing diuretics. How will the nurse respond when the client's family member asks why this is the case?

They may cause hyperkalemia.

A hospital client demonstrating peripheral edema has been prescribed furosemide. How should the nurse best determine the extent of the client's desired fluid loss?

Weigh the client daily

A nurse is providing patient teaching for a 62-year-old woman who is taking triamterene. The nurse will teach the patient to avoid what in her diet?

avocados

A 49-year-old client reports frequent muscle cramps while on hydrochlorothiazide therapy. The nurse would advise the client to do which?

eat potassium-rich foods.

A health care provider prescribes spironolactone, a potassium-sparing diuretic, for a client with cirrhosis. For which category of clients is the use of potassium-sparing diuretics contraindicated?

hyperkalemia

An older adult client has a complex medical history that includes heart failure, type 1 diabetes, and diabetic nephropathy. The nurse has questioned a health care provider's prescription for oral spironolactone because the client's health problems would contribute to a high risk of which adverse reaction?

hyperkalemia

A client is admitted to the emergency department with pulmonary edema. What diuretic does the nurse expect the health care provider to prescribe to achieve rapid therapeutic effect?

loop diuretic

Which would the nurse expect to find in a client receiving acetazolamide?

metabolic acidosis

A client is receiving hydrochlorothiazide. The nurse would expect to administer this drug by which route?

oral

A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed?

osmotic diuretic

A nurse is caring for a 78-year-old patient with renal insufficiency and chronic heart failure who is receiving rapid infusions of high-dose furosemide. It will be a priority for the nurse to monitor for:

ototoxicity

What would contraindicate the use of indapamide?

renal disease